The back is a complicated structure of vertebrae separated by discs, held together by ligaments and muscles. It must be flexible enough to provide a wide range of movements and yet strong enough to protect the spinal cord and the delicate nerve fibers which exit between each vertebrae. The proximity of the spinal cord and spinal nerve roots to the muscles and joints of the back is what makes a "bad back" so painful and so debilitating. The spine functions as a whole, so if we have mechanical disturbances in one part of the spine, even as far away from the low back as the neck, it can influence conditions in another area of the spine. Imbalances in the pelvis, problems in the sacroiliac joints, facet fixations, as well as joint restrictions in the mid-back and the neck, can contribute to the process of disc degeneration, weakening the joint and making it susceptible to injury. Back pain can be caused by any combination of sprained ligaments, strained muscles, herniated discs, and pinched nerves, any or all of which can lead to back pain.

Of course your spine could be normal in every way and become injured in a fall, accident, or sports injury. Just as often, however, weaknesses from lesser, earlier injuries accumulate and compound as the years go by so that eventually the simplest of movements - for example, bending over to pick up your shoes from the floor - can have painful results. In addition, arthritis, poor posture, lack of exercise, weight gain, and even psychological stress can cause or complicate back pain. Most back pain is mechanical in nature. Less frequently back pain can also directly result from medical pathology such as kidney stones, infections, blood clots, bone loss (osteoporosis), and others. A complete history and a thorough examination can rule in or rule out a wide range of possibilities.

Nerve PainThe possible causes of nerve disorders in the human body number literally hundreds but may be divided roughly into 7 categories as follows:

Direct Physical Pressure such as from herniated discs, osteoarthritic changes, spinal stenosis. Often referred to as a "pinched nerve".

By far the most common of these that result in neck pain radiating into the shoulder, arm, wrist, and hand or lower back pain radiating into the buttock, hip, leg, or foot is direct physical pressure. When a patient suffering from a ''bad back'' receives a diagnosis of ''pinched nerve'' the doctor is referring to direct physical pressure as the cause of the nerve pain.

Pinched NerveA pinched nerve occurs when too much pressure is applied for too long to a nerve by surrounding tissues—such as by bones, cartilage, muscles, tendons, ligaments, spinal discs or (rarely) tumor. Everyone has at one time or another applied too much pressure to the "funny bone" in their elbow which is actually the ulnar nerve. This physical pressure disrupts the nerve's function causing pain, tingling, numbness or weakness. Too much pressure applied for too long to a nerve along the spine results in much the same sensations.

Of the 7 broad categories resulting in nerve dysfunction only one - direct physical pressure - is properly referred to as a pinched nerve. The most common reasons for the direct physical pressure are as a result of the changes occurring with degenerative disc disease (DDD) and/or degenerative joint disease (DJD). Nerve pain resulting from direct physical pressure is called an entrapment neuropathy because the nerve is trapped or pinched by some structure. This term helps to distinguish them from neuropathies resulting from infection or disease.

ABOUT THE AUTHOR

Dr. Michael L. Hall, D.C. practices at Triangle Disc Care in Raleigh, North Carolina specializing in Spinal Decompression for the treatment of acute and chronic neck pain and back pain due to herniated, degenerated discs.